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Lyudmila Pivina,1 Gulnara Batenova,1 Nazarbek Omarov,1 Diana Ygiyeva,1 Assylzhan Messova,1 Galiya Alibayeva,2 Ulzhan Jamedinova,1 Ruslan Kurumbayev,1 Maksim Pivin3 1Department of Emergency Medicine, Semey Medical University, Semey, Abay Region, Kazakhstan; 2Semey Emergency Hospital, Semey, Abay Region, Kazakhstan; 3Nuclear Medicine Department, Center of Nuclear Medicine and Oncology, Semey, Abay Region, KazakhstanCorrespondence: Lyudmila Pivina, Email semskluda@rambler.ruBackground: One of the most serious complications of coronary artery stenting is restenosis and in-stent thrombosis; their prevalence can reach 20– 25%. Stent thrombosis can be acute (up to 24 hours), subacute (24 hours to 30 days), late (30 days to 1 year), and very late (> 1 year after previous stenting). In the patients with COVID-19 in intensive care units, the proportion of those with elevated troponin levels reached 25%.Objective: Evaluation of the association between COVID-19 and the development of in-stent thrombosis and restenosis of the coronary arteries based on the analysis of clinical cases and case series.Materials and Methods: We searched the PubMed and Scopus databases for relevant case reports and case series of stent restenosis and in-stent thrombosis associated with coronavirus infection (CVI) published between 2020 and the present. Thirty-eight full-text publications were screened and manually checked for analysis. We found 10 publications describing cases of thrombosis and restenosis of stents associated with coronavirus infection, of which only 2 were case series. In total, we analyzed 22 cases.Results: In the structure of in-stent restenosis and thrombosis, 59.1% were very late, 9.1% were late; 18.2% were considered subacute events, and 13.6% were acute events. All cases were angiographically confirmed. The main location of restenosis or thrombosis was the left coronary artery (LAD) (51.1%), thrombosis of the right coronary artery (RCA) occurred in 27.3%, and location in circumflex artery was in 22.7%. All patients had COVID-19 confirmed by a PCR test or the presence of immunoglobulins G and M. In fourteen patients (54.5%), an X-ray examination showed the presence of bilateral polysegmental infiltration.Conclusion: Analysis of publications demonstrates the association between restenosis and in-stent thrombosis in patients with coronary arteries disease (CAD) and coronavirus infection.Keywords: restenosis, in-stent thrombosis, stenting, COVID-19, coronary artery disease, case report, case series

Diana Ygiyeva, Lyudmila Pivina, Assylzhan Messova, Nazarbek Omarov, Gulnara Batenova, Ulzhan Jamedinova, Almas Dyussupov Department of Emergency Medicine, Semey Medical University, Semey, KazakhstanCorrespondence: Lyudmila Pivina, Semey Medical University, 103 Abay Str., Semey, 071400, Kazakhstan, Email semskluda@rambler.ruObjective: People without a medical education background who have the skills and knowledge to provide emergency care can be useful in emergencies, disasters, earthquakes, and pandemics to save or support the life of an injured person until hospitalization or the arrival of an emergency medical team. The purpose of the study is to assess the knowledge and skills of first aid in individuals without a medical education background within a year after training.Materials and Methods: The study sample included 643 people without a medical education background. The study participants attended basic first aid training, the sessions that lasted for 18 hours. Participants answered a 10-question skills test before and after completing the course, as well as 6 months and 1 year after training. SPSS version 20.0 (IBM Ireland Product Distribution Limited, Ireland) was used for the statistical assessment of data, employing Cochran’s Q test. Pairwise comparisons were made between different periods using the Wilcoxon test with Bonferroni correction.Results: The mean age of the participants was 36 for males, and 42 for females. In the sample, males accounted for 70% (n = 441) and females for 30% (n = 202). The first aid training provided to persons without a medical education background significantly increased their level of knowledge. After 6 and 12 months, their knowledge and abilities remained significantly higher than before the training. However, these results were lower than they had been immediately after training.Conclusion: The study demonstrated that first aid training significantly increased the knowledge level of non-medical individuals immediately after training and remained elevated after 6 and 12 months. However, there was a decline in the level of knowledge and skills over time, indicating the need for refresher training.Keywords: first aid training, effectiveness, non-medical people, emergency situation, Kazakhstan

Diana Ygiyeva, Lyudmila Pivina, Assylzhan Messova, Nazarbek Omarov, Gulnara Batenova, Ulzhan Jamedinova, Almas Dyussupov Department of Emergency Medicine, Semey Medical University, Semey, KazakhstanCorrespondence: Lyudmila Pivina, Semey Medical University, 103 Abay Street, Semey, Kazakhstan, Tel +77055227300, Email semskluda@rambler.ru

Diana Ygiyeva,1 Lyudmila Pivina,1 Assylzhan Messova,1 Zhanar Urazalina,1 Yuliya Semenova,1 Almas Dyussupov,1 Altay Dyussupov,1 Tatyana Belikhina,2 Marat Syzdykbayev,1 Gulnara Batenova,1 Ayaulym Akhmetova,1 Amber Adams3 1Department of Emergency Medicine, Semey Medical University, Semey, Abay Region, Kazakhstan; 2Nuclear Medicine Department, Center of Nuclear Medicine and Oncology, Semey, Abay Region, Kazakhstan; 3JoAnne Gay Dishman School of Nursing, Lamar University, Beaumont, TX, USACorrespondence: Assylzhan Messova; Lyudmila Pivina, Department of Emergency Medicine, Semey Medical University, Abay str. 103, Semey, Abay Region, Kazakhstan, Tel +7 777 2138307 ; +77055227300, Email assylzhan2006@mail.ru; semskluda@rambler.ruObjective: Consultation is an important and necessary aspect of patient care in the emergency department. We prospectively examined difficulties during the consultation process between paramedics and providers in emergency departments in Kazakhstan.Methods: The paramedics were interviewed using various platforms and face-to-face meetings. Questionnaires were administered to paramedics to gather feedback on the current consultation process. In our survey, 202 paramedics of ambulance from the cities of Semey, Pavlodar, and Ust-Kamenogorsk, located in the North and East of Kazakhstan took part.Results: Serious barriers to effective consultation were identified during consultations with cardiologists, pediatricians, and traumatologists. Weekends, as well as nighttime, are associated with more consultation difficulties. The most common problems for paramedics are non-attendance of the consultant, refusal of hospitalization by the consultant, and referral to other specialists and departments. More than 40% of the respondents noted the desire to share responsibility for the patient with medical consultants, which indicates uncertainty in their own knowledge due to the limited work experience of the majority of respondents.Conclusion: Barriers that arise during the consultation process of patients with emergency conditions can lead to unfavorable outcomes. Strategies to address these barriers are needed to improve the quality of patient care. This review aims to understand and evaluate the issues that arise during the consultation process.Keywords: emergency department, consultation, paramedics, prehospital medical care

Background: The neutrophil-to-lymphocyte ratio (NLR) is an independent predictor of the severity of coronary heart disease and COVID-19. This study aims to assess the predictive ability of the NLR in patients with in-stent restenosis after COVID-19., Materials and Methods: a cross-sectional study included 931 patients who underwent repeated myocardial revascularization between May 2020 and May 2023. The 420 patients of the main group had in-stent restenosis, of which 162 patients had COVID-19 previously. The control group included 511 patients without stent restenosis (107 patients had COVID-19 previously). All reported events were verified by hospital electronic records from the Complex Medical Information System., Results: The mean values of the NLR were 2.51 and 2.68 in the study groups, respectively. A statistically significant positive relationship in both groups was found between the NLR and troponin, D-dimer, C-reactive protein, creatinine, ALT, and AST. A statistically significant positive relationship was found between NLR and myocardial infarction (MI) in patients of both groups ( p = 0.004; p < 0.001, respectively) and a negative relationship with the ejection fraction ( p = 0.001; p < 0.036, respectively). An evaluation of the predictive ability of the clinical and laboratory predictors of recurrent myocardial infarction shows a high degree of utility of this model. The area under the ROC curve for AUC for NLR was 0.664 with 95% CI from 0.627 to 0.700 ( p < 0.001)., Conclusions: NLR is one of the significant factors for predicting the development of adverse outcomes in patients with revascularized myocardium after COVID-19.

Background: Emergency medical services (EMS) are intended to provide people with immediate, effective, and safe access to the healthcare system. The effects of pandemics on emergency medical services (EMS) have not been studied sufficiently. The aim of this paper is to assess the frequency and structure of calls at an ambulance station in Kazakhstan during the period of 2019-2023., Methods: A retrospective analysis was conducted to estimate the incidence of emergency assistance cases from 2019 to 2023., Results: An analysis of the structure and number of ambulance calls before the pandemic, during the pandemic, and post-pandemic period did not reveal significant changes, except for calls in urgency category IV. Patients of urgency category IV handled by an ambulance decreased by 2 and 1.7 times in 2020 and 2021, respectively, which appears to be related to quarantine measures. In 2022 and 2023, category IV calls were 4.7 and 4.5 times higher than in 2019., Conclusions: This study's findings suggest no changes in the dynamics of ambulance calls, except urgency category IV calls. The number of category IV urgent calls decreased significantly during the COVID-19 pandemic and increased in the post-pandemic period.

Introduction: Coronavirus infection is a risk factor for vascular thrombosis. This is of particular importance for patients undergoing myocardial revascularization since this infection can be a trigger for the formation of restenosis in the area of a previously implanted coronary stent. Understanding the risk factors for stent thrombosis and restenosis is of particular importance in individuals at risk for adverse outcomes. The rarity of such situations makes the present study unique., Objective: Studying the peculiarities of restenosis and thrombosis of the coronary arteries in patients after coronavirus infection., Methods: The study was performed in the Department of Cardiovascular Surgery of Emergency Hospital, Semey City, in 2021. We have examined the medical records of 10 consecutive patients with restenosis of coronary arteries after coronavirus infection and 10 matched-by-age patients with similar restenosis of coronary arteries who did not have coronavirus infection as a comparison group. To determine statistically significant differences between independent samples, we calculated the Mann-Whitney U test., Results: The average age of patients was 65.7 years. Only one case was classified as early restenosis (within 8 days of previous revascularization), two cases represented late restenosis, and seven cases were very late restenoses. In 70% of cases, restenosis was localized in the left anterior descending artery, in 30% of cases, it was in the right coronary artery, and in 40% of cases, it was in the left circumflex artery. In comparison with patients who did not have a coronavirus infection, there were statistically significant differences regarding IgG ( P < 0.001) and fibrinogen ( P =0.019)., Conclusion: Patients with myocardial revascularization in the past have a higher risk of stent restenosis against the background of coronavirus infection due to excessive neointimal hyperplasia, hypercoagulability, increased inflammatory response, and endothelial dysfunction., Competing Interests: The authors declare that there are no conflicts of interest., (Copyright © 2023 Gulnara Batenova et al.)